Artificial Urinary Sphincter Effective in Treating Male Urinary Incontinence After Prostate Surgery

Urinary incontinence can be a challenging condition, especially for men who have undergone prostate surgery. The gold standard for surgical treatment of male non-neurogenic Stress Urinary Incontinence (SUI) has long been considered the Artificial Urinary Sphincter (AUS). A recent meta-analysis published in PloS One by Yue Li and colleagues aimed to evaluate the effectiveness of AUS in treating male SUI following prostate surgery, shedding light on its clinical benefits.

Researchers conducted a comprehensive search across multiple databases to identify studies that examined the efficacy of the AUS AMS 800™ in treating SUI after prostate surgery in males. The primary outcome assessed was the degree of dryness after AUS

implantation. Complete dryness meant no daily pad use, while social dryness referred to using 0-1 pad per day. Secondary outcomes included the reduction in pad use and postoperative improvements in the quality of life.

The data included in this analysis primarily stem from prospective and retrospective cohort studies, with a limited number of controlled trials. Fortunately, these studies mostly adopted consistent criteria to evaluate the effectiveness of the Artificial Urinary Sphincter (AUS) in treating Stress Urinary Incontinence (SUI) in males after prostate surgery.

Pooling together data from a total of 19 studies, which comprised six prospective cohort studies, twelve retrospective cohort studies, and one randomized controlled trial, the following outcomes were observed:

● Pad Use Reduction: After the implantation of the AUS, there was a significant decrease in the number of pads used per day, with an approximate reduction of four pads (P < 0.001).

● Quality of Life Improvement: Patients reported a substantial enhancement in their quality of life following the procedure (P < 0.001).

However, it's important to note that the analysis revealed a considerable degree of heterogeneity among the studies, indicating variations in their findings. To better understand these differences, subgroup analysis was conducted based on the severity of baseline SUI. Although this helped reduce heterogeneity to some extent, the I2 statistic, which measures heterogeneity, remained above 50%. Interestingly, it was suggested that this heterogeneity might not be solely attributed to the severity of SUI.

To account for these variances, a random effect model was employed for data analysis, yielding the following results:

● Dry Rate: The overall dry rate after AUS implantation was approximately 52% (P < 0.001).

● Social Dry Rate: A notably higher social dry rate of around 82% was observed (P < 0.001).

The overall body of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines. The evidence

level for the dryness rate was deemed very low, while the evidence level for social dryness rate, pad use reduction, and improved quality of life was considered moderate to low.

Despite the reliance on descriptive studies and limited follow-up in the available evidence, the meta-analysis results indicate that AUS is effective in treating urinary incontinence in males who have undergone prostate surgery. Furthermore, AUS appears to significantly enhance patients' quality of life, offering a promising solution for a challenging condition. Further research and long-term studies are needed to solidify these findings and refine treatment approaches.

Reference:

Li, Y., Li, X., & Yang, Q. (2023). Effectiveness of artificial urinary sphincter to treat stress incontinence after prostatectomy: A meta-analysis and systematic review. PloS One, 18(9), e0290949. https://doi.org/10.1371/journal.pone.0290949.